262 final from the lovely dr savanna kirk

3 levels of prevention

primary, secondary, tertiary

primary prevention

focuses on health promotion and protection

NO DISEASE

secondary prevention

focuses on early identification of health problems

subclinical disease

tertiary prevention

focuses on restoration and rehab w goal of returning to optimal level of functioning

diagnosed disease

leadership styles

authoritatian, democratic, laissez-faire, bureaucratic

authoritatrian

-makes decisions for group or org

-dictator

-used for emergency situations

authoritarian leaders believe members are

-externally motivated, value reward system and incapable of independent decision making

-provides direction for group or org=just follow rules

-determines policies, gives orders

-productivity is high=creativity/autonomy/self motivation not met

-low levels of trust with in group

democratic

-facilitator

-encourages group discussion and decision making

democratic leaders believe members of group are

-intrinsically motivated and desire self-satisfaction

-capable of making decisions, values independence

-gathers info to make collective decisions

-provides constructive feedback, offers info, asks questions

-inclusive in decision making for group n org

-goals and measures are defined by leader n group

laissez faire

permissive way

recognizes groups need for autonomy

laisse faire leaders believe members are

-internally motivated and desire self satisfaction

-capable of making decisions and personally/professionally capable

-takes hands off approach

-group will make decisions and support the effort to move forward w decision

-leader acts as resource for group

-goals and measures are defined by group

Bureaucratic

-does not trust self or others

-viewed as inflexible and only following rules of the org

-relies on org rules, policies, and protocols to direct group efforts

-comes w group dissatisfaction

-leader=rule follower and viewed as inflexible

newer leadership theories

charismatic or transformational

charismatic leader

develops strong relationships with group members who commit to leader and motivated by their leader's personality

transformational leader

fosters creativity, risk-taking, commitment, and collaboration by empowering the group to share in the organization's vision

-valuable when org is going through significant change and under deadline

-engages and inspires stakeholders w clear and attainable goals

tasks that cant be delegated

education

teaching

evaluating

assessing

monitoring

tasks that can be delegated to LPN or NA

vital signs

I&O

bathing

delivering meal trays

feeding

turning

changing linens

weights

ambulation

simple dressing

CPR

LPN and NAs cannot

delegate to each other or above them

signs of impending death

jaw drop

difficulty speaking

decreased GI motility

incontinence

diminished sensation/hypersensation

mottling n cyanosis of extremities

cold skin

slower n weaker pulses

rapid, shallow, irregular breathing

death rattle-gurgling respiration

mouth breathing

greif and death

honor pt concerns, thoughts, n feelings if applicable

-beliefs abt prep of body, autopsy and organ donation, cremation and prolonging life depend on religion

-check clients religion rituals and make every attempt to comply

-handle deceased w dignity

5 stages of grief

1. Denial=world is meaningless n overwhelming

2. Anger

3. Bargaining=will do anything if only loved one would be spared

4. Depression

5. Acceptance

health problems that increase surgical risk

malnutrition

obesity

cardiac conditions: htn, hf, recent mi

blood coagulation disorders

URIs or COPD

renal disease

diabetes

liver disease

uncontrolled neurologic disease/epilepsy

early ambulation post surgery

promotes venous return

enhances lung expansion

stimulates GI motility

post op complications

*pneumonia and atelectasis

*hypoxemia

*pulmonary embolism

-hypovolemia

*hemorrhage

*hypovolemic shock

*thrombophlebitis

-thrombus/embolus

*urinary retention

-uti

-n/v

*constipation

-tympanites

* ileus

*wound infection

*wound dehiscence

*wound evisceration

physiologic outcomes of immobility

decreased metabolism

increased cardiac workload

decreased lung expansion

increased oxygen demand

types of diets

Liquid - Clear, Full

Soft - Mechanical soft

Pureed

Low sodium

Diabetes/Carb Controlled

Renal

Cardic

Liquid - Clear

water

apple juice

popsicles

tea

liquid ful

coffee w milk

orange juice

milk

arterial wound characteristics

dry, pale, punches out/well defined borders, necortic

arterial wounds pain

intermittent claudication

nocturnal pain

pain at rest

nocturnal pain is relieved by

placing limb in dependent position

signs of arterial wound

hair loss

ridging nails

thin/shiny nails

cool/cold skin

pale

venous wounds

shallow/irregular borders

large exudate

dark ruddy red (hemosiderin staining)

thin layer of slough

crusting

weeping

pitting edema (ankle to knee=worsens when dependent)

varicose veins

treatment of venous wounds

compression therapy/elevation

hypernatemia +causes

above 145

too much Na+ or too low on water

FVD/FVE

symptoms of hypernatremia

Thirst

Dry, sticky mucous membranes

Lethargy, weakness, irritability

disorientation and decreased LOC

treatment of hypernatremia

hypotonic fluids

diuretics

provide low sodium diet

hyponatremia +causes

less than 135

excess sodium excretion in urine (diabetes insipidus)

V/D/Gi suction

symptoms of hyponatremia

muscle cramps, weakness

anorexia

N/V/D, cramps

headache, depression, irritability, personality changes

coma

treatment of hyponatremia

LR or .9 NaCl

fluid resctriction

hyperkalemia + causes

above 5

renal impairment

hyperkalemia symptoms

diarrhea

irregular pulse

paresthesias

muscle tremors/weakness

cardiac arrest

hyperkalemia treatment

Calcium gluconate

insulin/dextrose

kayexalate

lasix

dialysis

hypokalemia + caues

below 3.5

d/v, gastric suctioning

hypokalemia symptoms

n/v, anorexia

weakness

dysrhythmias

leg cramps

ekg changes (flattened t waves)

treatment of hypokalemia

oral or IV replacement of potassium

-dark leafy greens

hypercalcemia + causes

above 10

hyperparathyroidism, malignancies

hypercalcemia symptoms

muscle weakness, fatigue

personality changes

anorexia., n/v

prevention of hypercalcemia

ambulation

hypocalcemia + causes

below 8.5

hypoparathyroidism alcoholism, acute pancreatitis

symptoms of hypocalcemia

tetany, paresthesia, muscles spasms

trousseau/chvostek's

hypotension

fractures

anxiety, confusion, psychosis

Trousseau sign

Chvostek's sign

Hypermagnesemia causes

renal insufficiency

hypermagnesemia symptoms

depressed DTR

hypotension

lethargy

respiratory depression

hypomagnesemia causes

Chronic alcoholism

Malnutrition

Diabetic Ketoacidosis

hypomagnesemia symptoms

muscle weakness

tremors

tachycardia, htn

mood/personality changes

alcoholism

-malnutrition is serious complication=thiamine deficient (B1)

-suppresses folate metabolism n lowers folate levels leading to anemia

-deficient magnesium levels bc poor absorption and diets

-most at risk for Hypocalcemia and Hypomagnesia

thiamine deficient (B1) results in

neurological impairment

blood count test

CBC

Hgb

Hct

RBCs

WBCs

platelets

liver function test

alanine amniotransferase (ALT)

aspartate aminotransferase (AST)

albumin

alkaline phosphatase (APT)

ammonia

bilirubin

prothrombin

cardiac markers

Creatine Kinase(CK)

Myoglobin

Troponin I

Troponin T

lipoprotein profile

Cholesterol, HDL, LDL, Triglycerides

BNP test

heart failure

clotting tests

Factor Xa

prothrombin time (PT)

international normalized ratio (INR)

partial thromboplastin time (PTT)

direct visualization/invasive tests

-scopy procedures

aspiration/biopsy

lumbar puncture

abdominal paracentesis

thoracentesis

indirect visualization/non invasive test

x rays

MRIs (no contrast)

CT

US

ECG

PET

US

ultrasound

sleep cycle

NREM=3 stages + REM= 1 cycle

NREM

non rapid eye movement

75-80% of sleep

3 stages

stage 1 NREM

a few minutes.

light sleep

easily awakened

HR n RR decreases

stage 2 NREM

lasts 10-15 min

light sleep

vital signs start to decrease

stage 3 NREM

deep sleep

delta waves

REM

rapid eye movement

-every 90 minutes

dreams

restlessness

may be skipped in first sleep cycle

obstructive sleep apnea

OSA

impaired gas exchange

irritability, memory n cog problems, excessive daytime sleepiness, morning headaches

preload

volume of blood in ventricles at end of diastole

-end diastolic pressure

increase preload w

hypervolemia

regurgitation of cardiac valves

hf

afterload

resistance left ventricle must overcome to circulate blood

increased afterload in

HTN

vasoconstriction

increased afterload, increase

cardiac workload

delirium

acute onset

fluctuating course

impaired awareness

poor working memory n immediate recall

delusions short-lived or changes AO status

fragmented sleep

dementia

insidious onset

gradual deterioration

awareness is clear until advanced stages

poor short term memory

more fixed w delusions/AO status

sleep wake reversal

SUNDOWNING

interventions w dementia n delirium

decrease stimulation=

decrease tv sound/no tv

close door/decrease noise level

decrease lighting

older adults changes in integumentary

dryness, pallor, fragility

wrinkling/sagging

age spots

decreased perspiration

thinning/graying hair

cardiovascular changes in older adults

reduces elasticity of vessels

increased rigidity of arteries

osteopathic older adult

kyphosis

restraint use

-ROM to restrained parts

-turning n repositioning

-skin care if skin assessment indicates need to

-checking circulation status of part

-two fingers should be able to fit btwn restraints n body

-providing for physical needs w toileting, hydration, nutrition

-providing patients psych needs like as much independence as possible, need for dignity n respect freedom from anxiety

type of pain

nociceptive and neuropathic

nociceptive pain

causes by activity in neural pathways in response to potentially tissue-damaging stimuli

neuropathic pain

arising as a direst consequence of a lesion or dysfunction in nervous system

incident/episodic pain

pain pathways are activated intermittently

Acute nociceptive pain

fractures

surgical pain

angina

cancer pain

chronic nociceptive pain

headaches

arthritis

fibromyalgia

cancer pain

acute neuropathic pain

crushes nerve

spinal cord compression

herpes zoster

cancer pain

chronic neuropathic pain

phantom limb

diabetic neuropathy

cancer pain

pain scales

simple description of pain intensity

0-10 scale

faces pain (wong bakers)=kids, adolescents. language barrier

-PAIN-AD

PAIN AD scale

pain assessment in advanced dementia scale